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Dr. Darrell White's Personal Blog

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Sunday musings 10/25/15: The Third Space

Sunday musings…

1) Technium. Science writer Kevin Kelly’s term for the “organism” that is our connected technology.

Once again, Asimov was right.

2) Signage. In this era of connectedness, where I can answer a question about the terminal from which my flight will depart or re-route my lost cabdriver, isn’t it fascinating that the sign on your building is still never lower than number 2 on the list of answers to “how did you find us”?

3) 3rd Space. I’ve been thinking about this a ton lately. We all have 3 spaces: home, work, and our 3rd space, that place we spend a substantial amount of the rest of our time. Howard Schultz, CEO of Starbucks, is quite famous for declaring that his coffee shops thrive because they become the 3rd space for so many of their customers. Having just spent a couple of hours killing time in a Starbucks waiting for a meeting I can certainly attest to this, at least in that rather large one.

For my folks and many in their generation the 3rd space was a club of some sort. My Mom and Dad have belonged to the same country club for 40 years and the majority of their social life has revolved around friendships made there. This kind of 3rd space need not be as fancy as a country club, though. Mrs. bingo and I were invited to a birthday party for one of our associates at a VFW outpost. When our friend walked in it was like a scene out or “Cheers”: everyone knew them there. Like my folks, that VFW has been a gathering place for this couple, a place for them to make and commune with friends.

One of the essential characteristics of a CrossFit Affiliate gym is that it very often becomes the 3rd space for its members and trainers. Everything about that must have come as a bit of a surprise to Coach, at least in the beginning, since his original business model was predicated on the close interaction between a trainer and 1, 2 or 3 clients. Indeed, you can see vestiges of these early teachings in the rising number of calls to return CrossFit training to something that more closely resembles what we’ve come to call “Personal Training”.

While I have a deep understanding of both Coach’s original intent when he discussed his earliest classes and the economic imperative behind at least some of the recent calls to move toward fewer clients paying higher fees, I think this would be a mistake if it means the death of the CrossFit class. Aside from the obvious, that CrossFit is simply a superior way to gain a general physical fitness, what has driven the explosive growth of all things CrossFit is this creation of a new 3rd space in the Box. While I don’t at all question the merits of one-on-one training, my bid is that this personal approach should be in addition to classic CrossFit workouts done in a group.

What we share in the Box is stronger than any differences that may separate us. Vocation, income, address…all of these things become irrelevant once we cross the threshold of the CrossFit gym. Like any true 3rd space we not only enter a zone where we are comfortable enough to be ourselves, but we exit this comfort zone in the company of friends and friendships that extend beyond the walls of the gym.

The magic may be in the movements, but the ability to bring together people from all walks of life into a new 3rd space is magical as well.

I’ll see you next week…

Comment – Posted by: bingo at October 25, 2015 7:26 AM

Lessons In Doctoring Learned On The Golf Course

I’ve been thinking a lot about health care recently. Real health care, not Health Care as in “Health Care Crisis” or “Health Care Reform”, but the kind of health care that is provided by doctors and nurses and all kinds of other health care providers. You know, like making sick people better, and keeping healthy people healthy. The kind of health care that old guys like me (I’m 52, in case you were wondering) got from pediatricians like Dr. Roy in Southbridge, MA in the 60′s, or like my sons get from Dr. Gerace in Westlake, OH today.

I did a lot of thinking about this some 7 or so years ago, too, when I developed the concepts that eventually resulted in Skyvision Centers. My mini-epiphany at that time is that medicine is the ultimate consumer service business. At its core medicine is about one group of people providing a service to another group of people who either want or need that service. It’s the most intimate type of service, too. One to one. Face to face. You and me.

There is a remarkable lack of difference between doctors (and hospitals, for that matter) when you look at the outcomes that arise from that service– how many people get better after receiving medical care for their illnesses. The difference between the top 1 or 2% of doctors and the 50th percentile in terms of real medical outcomes is remarkably small, and much smaller today than it was in the days of my Dr. Roy.

Sure, there are differences in how people arrive at getting better. Some very instructive studies from Dartmouth have shown dramatic regional differences in the U.S. in how much money is spent on treating heart attacks, for instance. By and large, though, the same number of people get the same amount of better no matter where they are treated or from whom they received that treatment, and the quality of those treatments is several orders of magnitude greater and better than it was in my youth.

So what was it about Dr. Roy that people in my generation seem to have so much trouble finding in medical care today? If the treatment of diseases is so much better now why do so many people complain about medical care today? Why is it that Dr. Gerace has people lined up waiting to see him while other doctors don’t? Why do people rave about their experience at Skyvision Centers and complain so bitterly when they need to have a consultation at some of the most famous medical institutions in Cleveland?

I think it’s because Dr. Roy, Dr. Gerace, and I were all, once upon a time, caddies.

Seriously. We spent the earliest part of our working lives on the lowest rung of the service ladder, providing one-on-one service for a single customer. Because of that I think each of us realized that what really sets doctors (and hospitals) apart is what a patient experiences when they visit. The most successful doctors and the most successful medical practices are those who have realized that the central character in the play is the patient. The most successful caddies never forget that the most important person on the course is the golfer. The job of the caddy is to help the golfer perform a well as possible (maximize the health of her game) while at the same time making sure that she has a wonderful experience on the golf course.

Ben Stein wrote a column in the NY Times about his first real job; he was a shoe salesman. Imagine, at 17 years of age, selling shoes. Days filled with all manner of customers and handling the foot of each and every one of them. Customer service and sales is “learning the product you are selling, learning it so well that you can describe it while doing a pirouette of smiles for the customer and talking about the latest football scores” no matter who that customer might be. Tinker, tailor, soldier or spy, junior partner or janitor. Be they humble or haughty, gracious or grating. Totally focused on that one customer in front of you in order to provide them that service. The same can be said for any front line service job. Waitress in a diner, car mechanic, you name it.

My first summer job was caddying, and I caddied for parts of each summer through medical school. As I think about it now after reading Stein’s article it’s amazing how many parallels there are between my first job as a caddy and my career as an eye surgeon. I toted the bags for one or two golfers at a time; I usually have a patient, patient and spouse, or parent and child in the office. I was a better golfer than almost all of the men and women for whom I caddied; I know more about the eye than every patient who visits, google notwithstanding. In both circumstances my success was/is determined by my customer’s (golfer/patient) outcome, their “score”, as well as their view of the experience. Even a career-best round doesn’t feel quite as enjoyable if it took place over 6 hours in the company of a surly caddy!

I’ve told the story of how being a caddy turned into Skyvision Centers; it’s a neat story and I love telling it. For the moment, though, I have a little experiment for anyone who might be listening, and a modest suggestion for the powers that be in medical education (who most assuredly AREN’T listening). The next time you visit a doctor ask him or her what their first couple of jobs were. See if you can predict which of your doctors or dentists (or nurses) had what kind of jobs before their medical career based on the kind of experience you’ve had in their offices or institutions.

Let’s add a little time to the education of the folks who take care of our medical problems, especially our doctors. How about 6 months selling shoes at Nordstrom’s. Or a year of Sunday mornings slinging hash at a local diner. Better yet, let’s get all of those pasty washed-out interns out on the golf course with a bag on their shoulder and a yardage book on their hip, golf hat slightly askew and Oakleys on tight. Let ‘em learn how to take care of a customer without the huge advantage of all that medical knowledge. We’ll take the best of them and turn them loose in offices all across the land. Those who can’t hack it, the ones who can memorize the history of Florsheim but can’t bring themselves to touch a foot, who are scratch golfers but can’t bring themselves to congratulate the hacker who sinks a 30 foot double-breaker, those we’ll hide in the lab, or put them in huge, anonymous medical centers, one more anonymous member of an anonymous team hiding under the brand umbrella of some “World Class Clinic”  where one-on-one customer service never really happens.Because the ultimate consumer service business is medicine.

Just ask a caddy.